Mitral Stenosis

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Mitral stenosis is a narrowing of the mitral valve (stenosis) that results in the back-up of blood into the top chamber (left atrium) of the heart. This can cause fluid in the lungs and irregular heart rhythms, such as atrial fibrillation. This valve problem typically occurs either as a result of age-related calcification or complications of rheumatic fever.

Symptoms of mitral valve stenosis may include:

Waking up with difficulty breathing (most common symptom)

Cough, possibly bloody

Difficulty breathing during or after exercise or when lying flat

Fatigue

Frequent respiratory infections, such as bronchitis

Heart palpitations

Swelling of feet or ankles

Chest discomfort/tightness (rare)

The picture above shows the difference between a normal mitral valve and a valve with mitral valve stenosis.

Mitral valve stenosis is diagnosed with:

Physical exam, to listen for a heart murmur during the relaxing phase of the cardiac cycle (diastole)

Echocardiography, to identify the narrowed mitral valve and measure the severity

Transesophageal echocardiography to clarify the extent of the thickening of the mitral valve

Cardiac catheterization, an invasive procedure used to evaluate the severity of the narrowing and to obtain accurate measurements of the pressures in the heart in order to determine the optimal treatment strategy

Mitral valve treatment options include:

Mitral valve replacement

Surgical commisurotomy, a procedure to open a blocked or defective mitral valve

Balloon valvuloplasty, a procedure performed in the cardiac catheterization laboratory in which a balloon is inflated within the narrowed valve to open it up

Medical management with medications to treat symptoms of mitral stenosis, including beta blockers to slow the heart rate and diuretics to remove excess fluid